An Overview of Cheilitis

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Cheilitis, or "lip inflammation," is a condition that manifests as red, dry, scaling, and itchy lips. Many different factors can cause cheilitis, such as an infection, chronic lip licking, or exposure to an allergen or irritant (including lip cosmetics, oral hygiene products, fragrances, or certain foods).

Doctors diagnose cheilitis by reviewing a person's medical history and performing an examination of the mouth, lips, and skin. Sometimes, other tests, like patch testing or a biopsy are performed to determine the root cause of the inflammation.

The treatment of cheilitis depends on the underlying cause—for example, treating the infection or removing the offending irritant. In addition, a skin medication called a topical ("on the skin") corticosteroid is often recommended to help soothe the inflamed lips.

Symptoms

The most common "lip" symptoms associated with cheilitis include:

  • Dryness
  • Redness
  • Scaling or fissuring
  • Tenderness
  • Cracking or peeling
  • Swelling (edema)
  • Itching and burning sensation
  • Crusting at the corners of the mouth (angular cheilitis)
  • Brown-black discoloration of the lips (seen with certain types of irritant contact cheilitis)

Rarer symptoms may include the presence of a thick keratin scale on the lips (seen with exfoliative cheilitis). A thickening of the lower lip along with tiny orifices (holes) where saliva can be expressed is seen with glandular cheilitis.

Causes

There are different types of cheilitis, based on what causes them.

Eczematous Cheilitis

The most common type of cheilitis is eczematous cheilitis which may be associated with atopic disease (eczema, hay fever, and asthma) or occur as a result of an allergen or irritant exposure.

Atopic cheilitis is commonly seen in people with eczema but is often indistinguishable from allergic or irritant contact cheilitis but

Allergic or irritant contact cheilitis is caused by a reaction to an irritant or allergen that touches the lips, such as:

  • Lipstick or lip balms
  • Oral hygiene products, like toothpaste or mouthwash
  • Fragrances (e.g., balsam of peru)
  • Rubber or latex products
  • Nail polish substances (e.g., formaldehyde)
  • Metals (e.g., nickel, cobalt, or gold)
  • Certain foods (e.g., mango or cinnamon)
  • Certain medications (e.g., neomycin or bacitracin)
  • Propylene glycol
  • Chronic lip-licking
  • Weather-related factors (e.g., cold or wind)
  • Sunscreen

Angular Cheilitis

Angular cheilitis causes inflammation of the skin located at the sides or "angles" of the mouth. Basically, saliva collects at the angles of the mouth, eventually leading to dryness and cracking of the skin as the saliva dries up. Secondary infection with the fungus, Candida albicans ("yeast"), or less commonly the bacteria, Staphylococcus aureus ("Staph"), may then develop.

Certain people are more prone to developing angular cheilitis, such as those with diabetes or older individuals who wear dentures. People who take medications that cause dryness, like isotretinoin (formerly Accutane) for acne may develop this condition. Those with a vitamin B or iron deficiency are also more prone.

It is important to note that angular cheilitis does not only affect adults. Children who drool, suck their thumbs, or lick their lips in the wintertime are also at a greater risk for developing this condition.

Actinic Cheilitis

Actinic cheilitis is also called solar cheilitis because it is caused by long-term sun exposure. It is a pre-cancerous condition (squamous cell carcinoma of the lip) that most commonly occurs in light-skinned individuals, and in people who live in hot, dry climates and/or work outdoors, like construction workers.

Rare Types of Cheilitis

Other types (albeit rare) of cheilitis include:

  • Exfoliative cheilitis—possibly related to chronic lip-licking or biting
  • Glandular cheilitis—possibly related to sun exposure, lip biting, and smoking
  • Cheilitis granulomatosa (also called Miescher's cheilitis)—tends to affect young adults, and experts suspect it is caused by a combination of factors, including genes, infection, and food allergies

Diagnosis

When diagnosing cheilitis, your doctor will perform a detailed medical history that explores potential exposures (e.g., cosmetics or foods). The health care provider will also perform a skin examination that includes the mouth and lips.

Depending on your doctor's underlying suspicion, other tests may be performed, such as:

  • Patch testing (used to diagnose allergic contact cheilitis)
  • A swab of the lip to check for infection
  • A biopsy (when a tiny piece of tissue from your lip will be removed and examined under the microscope)

Treatment

The treatment of cheilitis depends on the underlying cause.

Eczematous Cheilitis

For all forms of eczematous cheilitis, topical (on-the-skin) corticosteroids along with a lip balm or emollient, like vaseline, can help calm down the lips and reduce any itching sensations.

In the case of irritant or allergic contact cheilitis, removing the offending irritant/allergen is key (for example, avoiding a certain lip balm or toothpaste).

Angular Cheilitis

For angular cheilitis (also known as perleche), treating the underlying infection is important. This entails applying a topical antifungal (for a yeast infection) or antibiotic (for a bacterial infection) ointment to the sides of the mouth, and then applying a protective lip balm or barrier cream, like zinc oxide or vaseline, once the infection clears up.

Addressing the root problem is also essential. This may mean improving denture fit or taking a vitamin or iron supplement.

Actinic Cheilitis

There are several potential treatment options for actinic cheilitis, depending on the severity, such as:

  • Cryotherapy (freezing)
  • Topical therapies (e.g., fluorouracil or imiquimod)
  • Photodynamic therapy (light treatment)
  • Surgical excision (removal) of part of the lip
  • Laser ablation

A Word From Verywell

Cheilitis is a common, inflammatory skin condition. While it may be uncomfortable and cosmetically unappealing, the good news is that in the vast majority of cases, it can be treated with straightforward and simple measures.

If you think you may have cheilitis or notice any new changes with your lips or the skin surrounding your lip, be sure to make an appointment with your doctor.

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